Measles Alert

The Vermont Department of Health is investigating a laboratory-confirmed case of measles in an unvaccinated individual from Southeastern Vermont. Onset of fever and rash occurred on May 23, 2011 and the individual was likely infectious from May 19 through May 27. The incubation period for measles averages 10 to 12 days. Rash onset averages 14 days (range, 7-18 days) from exposure.

The Health Department has followed up on the limited exposures that were identified in Vermont. At this time, no secondary cases have been identified. However, measles transmission is occurring in surrounding states, including the Boston, Massachusetts and Albany, New York areas. Of the 118 cases confirmed in the U.S. during the first five months of 2011, 40 percent have resulted in hospitalization. Outbreaks also continue in Europe. France has experienced approximately 10,000 cases reported during the first four months of 2011, including 12 cases of encephalitis, 360 cases of severe measles pneumonia, and six measles-related deaths.

Actions Requested –

Watch for possible cases of measles in Vermont. A suspected case of measles requires prompt public health intervention to decrease the risk of transmission. Measles presents with prodromal fever, cough, coryza and conjunctivitis. An erythematous maculopapular rash appears on the third to seventh day, starting at the hairline and descending in a centrifugal pattern.

Report suspect measles cases promptly to confirm diagnosis. Contact the Health Department’s Epidemiology Unit to report suspect cases and to arrange for measles testing available through the Vermont Department of Health Laboratory. Call 802-863-7240 (800-640-4374 in Vermont). An epidemiologist is available 24/7.

Serologic testing is required to confirm measles diagnosis. Obtain 2 mL of serum when the patient presents for medical evaluation. If the specimen is collected < 3 days after rash onset, repeat testing may be requested if the IgM is negative. Vaccine status can affect results – please discuss with Epidemiology. Throat or nasopharyngeal swabs are generally the preferred sample for virus isolation or RT-PCR detection. A first void urine specimen for measles viral culture should also be obtained. Testing will be arranged through the CDC.

Review immunization records for your patients. Make certain they have received age-appropriate vaccines. International travelers should also be urged to receive appropriate immunizations, including a measles-containing vaccine.

Ensure adequate measles immunization or measles immunity for all office/hospital staff, along with strict adherence to appropriate infection control measures for patients presenting with febrile rash illnesses. Measles is a highly communicable disease. Patients in waiting rooms are considered exposed to measles for up to 2 hours after an infectious patient has been in the same room.

For questions related to this advisory, call 802-863-7240 (800-640-4374 in Vermont).